Provider Demographics
NPI:1518928746
Name:GHOBRIAL, TOM (MD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:
Last Name:GHOBRIAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12252 WILLIAMS RD SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7960
Mailing Address - Country:US
Mailing Address - Phone:240-362-7333
Mailing Address - Fax:240-362-7391
Practice Address - Street 1:12252 WILLIAMS RD SE
Practice Address - Street 2:SUITE 101
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-7960
Practice Address - Country:US
Practice Address - Phone:240-362-7333
Practice Address - Fax:240-362-7391
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD745163600Medicaid
MDWO33OtherCAPITOL BLUE SHIELD
MD0098553000Medicaid
MDLQ21OtherBLUE SHIELD MARYLAND
MD451653OtherMAMSI/MDIPA/ALLIANCE
MD200039203OtherRAILROAD MEDICARE
MD6529101-004OtherCIGNA
MDG52076Medicare UPIN
MD745163600Medicaid